Drugs & Aging最新文献

{"title":"Efficacy and Safety of Mirabegron in Frail Older Adults with Overactive Bladder.","authors":"Christina Shaw, Adrian Wagg","doi":"10.1007/s40266-026-01300-1","DOIUrl":"https://doi.org/10.1007/s40266-026-01300-1","url":null,"abstract":"<p><p>Overactive bladder (OAB) is a commonly occurring condition in older adults that has significant consequences on health and quality of life. In later life, many older adults also live with frailty, a condition characterized by vulnerability to insult and associated with a lesser probability of a full recovery. Frail older adults comprise a distinct group of older adults, often living with complex comorbid disease. There is a bidirectional relationship between frailty and OAB, though causation has not been established. β₃-Adrenoreceptor agonists like mirabegron offer a pharmacological alternative over antimuscarinics, which may be associated with intolerable side effects in older patients. While mirabegron has demonstrated efficacy and tolerability in community-dwelling older adults, prospective studies on its use in frail older adults remain limited. Here, we review available evidence on use of mirabegron in older adults and frail older adults, including safety, tolerability and efficacy. Evidence suggests that mirabegron has favourable safety and side effect profiles, decreases OAB symptoms, and improves quality of life. Mirabegron remains an acceptable alternative to antimuscarinic treatment in older adults and frail older adults.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Non-interventional Changes of the FORTA Score are Associated with Changes of Cognitive and Physical Function Tests in Community-Dwelling Older People.","authors":"Farhad Pazan, Julia Knorr, Christel Weiss, Kathrin Heser, Alexander Pabst, Melanie Luppa, Birgitt Wiese, Horst Bickel, Siegfried Weyerer, Michael Pentzek, Hans-Helmut König, Christian Brettschneider, Dagmar Lühmann, Marion Eisele, Wolfgang Maier, Martin Scherer, Steffi G Riedel-Heller, Michael Wagner, Martin Wehling","doi":"10.1007/s40266-026-01301-0","DOIUrl":"https://doi.org/10.1007/s40266-026-01301-0","url":null,"abstract":"<p><strong>Background: </strong>Listing tools were found to ameliorate drug treatment in older people; the FORTA (Fit-fOR-The-Aged) list is a clinically validated positive-negative list of medication appropriateness. Here, we retrospectively analyze longitudinal correlations between the FORTA score and key measures of physical and cognitive function in older people.</p><p><strong>Methods: </strong>504 participants of a multi-center cohort study (AgeCoDe/AgeQualiDe) for whom the FORTA score (sum of over- and under-treatment errors) had been assessed were studied at three follow-up (FU) time points (FU 6-8; mean age range 87.9-89.7 years); comparisons between data at these FUs separated by 10 months were available for 292-328 patients.</p><p><strong>Results: </strong>The univariate analysis of the association between FORTA_Delta_76 (change of FORTA score between FU 6 and 7) and ADL (Activities of Daily Living)_Delta_76 (- 0.155, p < 0.01) and between FORTA_Delta_76 and MMSE (Mini-Mental State Examination)_Delta_76 (- 0.203, p < 0.01) revealed significant correlations. Multivariable analysis (using a forward selection model, p < 0.05) revealed a significant association between FORTA_Delta_76 and MMSE_Delta_76 (p < 0.05). Univariate analyses for other comparisons were only significant for FORTA_Delta_86 and MMSE_Delta_86.</p><p><strong>Conclusion: </strong>This study indicates that longitudinal non-interventional changes of the FORTA score as an integral index of medication appropriateness are associated with changes in ADL and MMSE: the lower this score the better the functional outcome. These findings are in line with earlier interventional data and underscore the potential of FORTA to improve clinical endpoints in older people.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes Toward Deprescribing Among Community-Dwelling Adults: A Cross-Sectional Study in Community Pharmacies.","authors":"Elodie Marcellaud, Tassadit Merabtine, Jérémy Couturas, Zeinab Tarhini, Hugo Célèrier, Simon Ageorges, Préscillia Alves Gomes, Achille Tchalla, Édouard Desvaux, Jérémy Jost","doi":"10.1007/s40266-026-01298-6","DOIUrl":"https://doi.org/10.1007/s40266-026-01298-6","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to identify patient-related factors associated with attitudes toward deprescribing and to explore perceived barriers and facilitators among community-dwelling adults.</p><p><strong>Methods: </strong>A cross-sectional observational study was conducted in 60 community pharmacies across the Haute-Vienne and Dordogne regions of France. Eligible participants were adults aged ≥ 55 years, with at least one chronic condition and taking five or more chronic medications. Pharmacies were selected using a random cluster sampling method stratified by geographic area. Consecutively recruited patients completed an anonymous self-administered questionnaire assessing their attitudes toward deprescribing, perceived medication burden, and potential barriers or facilitators. Sociodemographic and clinical data were also collected. Multivariate logistic regression was used to identify factors associated with acceptance of deprescribing.</p><p><strong>Results: </strong>Among the 505 included patients (mean age 71.9 ± 9.0 years), 24.6% were reluctant to deprescribe. The main reasons for reluctance were the perceived effectiveness of their treatment (56.5%) and the fear of symptom recurrence (35.5%). Sleep disorders (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.33-0.78; p = 0.002) and urinary incontinence (OR 0.58, 95% CI 0.34-0.96; p = 0.048) were significantly associated with refusal of deprescription. Perceived medication overload (OR 1.82, 95% CI 1.12-2.95; p = 0.015) and restrictive treatment burden (OR 1.76, 95% CI 1.07-2.89; p = 0.026) were significantly associated with acceptance of deprescription.</p><p><strong>Conclusion: </strong>Attitudes toward deprescribing were positive among community-dwelling adults. Medication burden was associated with acceptance, whereas sleep disorders and urinary incontinence were associated with reluctance. Patient perceptions and clinical conditions should be considered when implementing deprescribing interventions.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially Inappropriate Prescription and Its Association with Index Hospitalization: A Multicenter, Cross-Sectional Study Using TIME Criteria.","authors":"Gulistan Bahat, Serdar Ozkok, Tugba Erdogan, Birkan Ilhan, Meryem Merve Oren, Duygu Erbas Sacar, Busra Can, Bahar Tekin Cetin, Timur Selcuk Akpinar, Rana Tuna Dogrul, Kamile Silay, Suna Burkuk, Meltem Halil, Fatma Erol, Sumru Savas, Sevnaz Sahin, Pinar Arman, Deniz Suna Erdincler, Emine Gemci, Sevgi Aras, Murat Varli, Melike Yazici, Suna Avci, Asli Tufan, Banu Ozulu Turkmen, Betul Gulsum Yavuz Veizi, Mehmet Ilkın Naharci, Ilker Tasci, Gozde Sengul Aycicek, Zekeriya Ulger, Funda Salgur, Huseyin Doruk, Umut Karabay, Mehmet Akif Karan","doi":"10.1007/s40266-026-01282-0","DOIUrl":"10.1007/s40266-026-01282-0","url":null,"abstract":"<p><strong>Background and objective: </strong>To evaluate the prevalence and types of potentially inappropriate prescriptions (PIP) in hospitalized older adults and to study whether PIP was a causative factor for index hospitalization, using the Turkish Inappropriate Medication Use in oldEr adults (TIME) criteria.</p><p><strong>Methods: </strong>This multicenter, cross-sectional study included 405 inpatients aged ≥60 years from 13 tertiary hospital departments in Turkiye between January 2020 and April 2021. PIP were assessed using TIME criteria, which include both potentially inappropriate medications, PIM (TIME-to-STOP) and potential prescribing omissions, PPO (TIME-to-START). Following the completion of medical history taking, physical examination, and comprehensive geriatric assessment (CGA), managing physicians evaluated each criterion individually. Based on clinical adjudication, they determined whether any PIM or PPO predefined in the TIME criteria could plausibly have contributed to the hospitalization.</p><p><strong>Results: </strong>The prevalence of PIP was 82.5%, with 63.2% of patients meeting at least one TIME-to-STOP and 71.6% meeting one TIME-to-START criterion. The top-three most common PIM identified via TIME-to-STOP criteria were: Long-term proton pump inhibitor (PPI) use without indication with 7.2%, PPI use for uncomplicated peptic ulcer disease, or erosive peptic esophagitis at full therapeutic dose for > 8-12 weeks with 3.0%, and diuretic use as first-line treatment of essential hypertension with concurrent urinary incontinence with 3.0%. The top-three most common PPO identified via TIME-to-START criteria were: Herpes zoster vaccination with 73.6%, Seasonal influenza vaccination annually with 59.3%, and Pneumococcal vaccination after age 65 with 57.3%. Among all participants, 34.1% had PIP causally related to hospitalization. Overtreatment of hypertension in patients with frailty was the most common PIM-related hospitalization factor (2.5%). Lack of oral nutritional supplements in patients with malnutrition was the leading PPO linked to hospitalization (11.6%).</p><p><strong>Conclusions: </strong>PIP were highly prevalent in hospitalized older adults and frequently contributed to hospital admission. TIME criteria provided a comprehensive and context-adapted tool for identifying both inappropriate medication use and missed treatment opportunities. Routine implementation of TIME criteria-guided medication reviews may represent a promising strategy to enhance medication safety and reduce avoidable hospitalizations in older populations, warranting further investigation.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"433-444"},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular-Related Polypharmacy and Its Association with Liver and Kidney Function: A Cross-Sectional Study Using Primary Care Data.","authors":"Caroline Trin, Harvey Jia Wei Koh, Zhomart Orman, Dianna J Magliano, Ella Zomer, Zanfina Ademi, Stella Talic","doi":"10.1007/s40266-026-01297-7","DOIUrl":"10.1007/s40266-026-01297-7","url":null,"abstract":"<p><strong>Background: </strong>Individuals at high risk of cardiovascular disease (CVD) often require multiple concurrent medications, resulting in polypharmacy. Although necessary for disease management, polypharmacy may increase the risk of adverse outcomes, including kidney and liver dysfunction. This study aimed to examine the association between CVD-related polypharmacy and biochemical indicators of kidney and liver dysfunction among patients prescribed lipid-lowering therapy in Australian primary care.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study of electronic medical records of adults prescribed lipid lowering therapy between January 2013 and December 2022. CVD-related polypharmacy was defined as the concurrent use of more than five cardiovascular medications within a 365-day sliding window. Liver dysfunction was defined by elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), or bilirubin levels and kidney dysfunction was defined by reduced estimated glomerular filtration rate (eGFR). Multivariable logistic regression was used to assess associations, adjusting for age, sex, and comorbidities.</p><p><strong>Results: </strong>Among 13,568 participants (median age 63 years, interquartile range [IQR] 54-72; 54% male), 33.7% had CVD-related polypharmacy. Diabetes (odds ratio [OR] 5.40, 95% confidence interval [CI] 4.96-5.93), chronic kidney disease (OR 2.39, 95% CI 2.00-2.86), and hypertension (OR 1.91, 95% CI 1.75-2.07) were significant predictors. Older adults (≥80 years) had higher odds of CVD-related polypharmacy (OR 8.17, 95% CI 5.47-12.21). CVD-related polypharmacy was significantly associated with kidney dysfunction (OR 1.45, 95% CI 1.30-1.62), but not statistically significantly associated with liver dysfunction (OR 1.19, 95% CI 0.59-2.37).</p><p><strong>Conclusion: </strong>CVD-related polypharmacy is common among individuals receiving lipid-lowering therapy and is strongly linked to ageing and multimorbidity. Its association with kidney dysfunction suggests an interplay between cardiovascular risk, physiological decline, and treatment burden, highlighting the need for integrated, patient-centred prescribing in high-risk populations.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"457-467"},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propofol Use and Delirium in Patients Aged 80 Years and Over: A Retrospective Cohort Study of 9850 ICU Admissions.","authors":"Shengnan Kong, Xinya Li, Weisheng Chen, Bo Chen, Han Shi, Jun Lyu, Yu Wang","doi":"10.1007/s40266-026-01296-8","DOIUrl":"10.1007/s40266-026-01296-8","url":null,"abstract":"<p><strong>Objectives: </strong>There is inconsistent evidence regarding the relationship between propofol and delirium, and this evidence is predominantly drawn from mixed-age adult cohorts. In this study, we examined the link between propofol exposure and the onset of delirium in patients aged 80 years and over-a rapidly growing and physiologically distinct intensive care unit (ICU) patient group.</p><p><strong>Design: </strong>We conducted a retrospective analysis of older adults (aged 80 years or over) included in the Medical Information Mart for Intensive Care (MIMIC-IV) database. We used multivariate logistic regression to examine the relationship between propofol use and the occurrence of delirium. To strengthen the reliability of our results, we performed sensitivity analyses using propensity score matching and inverse probability of treatment weighting, as well as subgroup analyses.</p><p><strong>Results: </strong>Among 9850 ICU patients aged > 80 years, delirium was observed in 3474 cases (35.3%). Propofol showed an independent association with delirium after covariate adjustment (OR 1.22, 95% CI 1.09-1.38). This significant link was confirmed by sensitivity analyses using inverse probability of treatment weighting (OR 1.22; 95% CI 1.09-1.38) and propensity score matching (OR 1.24; 95% CI 1.08-1.43). This finding remained consistent across most of the subgroup analyses.</p><p><strong>Conclusions: </strong>These findings highlight the importance of careful sedation planning and increased monitoring when administering propofol to critically ill adults aged 80 years and over, who may be particularly susceptible to its neurocognitive effects.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"445-455"},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing Cascades: An Umbrella Review and Updated Systematic Review.","authors":"Massimo Carollo, Salvatore Crisafulli, Marta Zerio, Francesco Maccarrone, Anna Paladin, Margherita Selleri, Anna Forti, Francesco U S Mattace-Raso, Gianluca Trifirò","doi":"10.1007/s40266-026-01295-9","DOIUrl":"10.1007/s40266-026-01295-9","url":null,"abstract":"<p><strong>Background: </strong>Prescribing cascades (PCs) often remain underrecognized, contributing to inappropriate prescribing and increased healthcare burden.</p><p><strong>Objective: </strong>This study aimed to synthesize existing knowledge on reported PCs and identify the medications and adverse drug reactions (ADRs) involved.</p><p><strong>Methods: </strong>An umbrella review was conducted using PubMed, Embase, Cochrane Library, Web of Science, and Scopus (inception-16 July 2025). Systematic and scoping reviews on potential PCs were included. An updated systematic review, using the same databases, was conducted to cover the period from 16 February 2022 (the end date of the search period in the most recent included review) to 16 July 2025 to identify more recent studies.</p><p><strong>Results: </strong>Two systematic and two scoping reviews were included in the umbrella review, for a total of 156 primary studies, and 34 more studies met the inclusion criteria of the updated systematic review. Overall, 84 different ADRs potentially leading to PCs were described. Medications mostly involved in the onset of ADRs leading to PCs were antidepressants, antidementia drugs, antipsychotics, anxiolytics, hypnotics/sedatives, lipid-modifying agents, and antihypertensives. The most frequently reported ADRs belonged to the \"psychiatric disorders,\" \"nervous system,\" and \"gastrointestinal disorders\" system organ classes. Prescription sequence symmetry analysis (PSSA) emerged as the most used method for PC identification.</p><p><strong>Conclusions: </strong>PCs are an underrecognized driver of inappropriate polypharmacy, especially in older adults, yet current evidence is largely retrospective and heterogeneous. By consolidating available data, our work provides a valuable reference tool for clinicians and researchers. Future efforts should focus on establishing standardized definitions and developing clinical strategies to prevent inappropriate PC use.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"397-424"},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harms of Continued Antihypertensives: An Overview of Reviews.","authors":"Carmen Floriani, Angela Edith Schulthess-Lisibach, Martina Zangger, Marc von Gernler, Maja Josephine Lundberg Andersen, Sven Streit","doi":"10.1007/s40266-026-01285-x","DOIUrl":"10.1007/s40266-026-01285-x","url":null,"abstract":"<p><strong>Background: </strong>Antihypertensives are effective drugs for treatment of hypertension, which is one of the most important risk factors for cardiovascular morbidity. Intensive hypertension treatment significantly reduces cardiovascular risk among older people. Based on these findings, guidelines recommend stricter blood pressure management nowadays. Reasoning on benefit and harms of antihypertensive treatment can be challenging in daily practice because little evidence is available on specific harm outcomes.</p><p><strong>Objective: </strong>With this overview of reviews, we aim to summarize evidence from systematic reviews on harms associated with continued antihypertensive treatment.</p><p><strong>Methods: </strong>We searched Ovid MEDLINE, Ovid Embase and the Cochrane Library for systematic reviews with or without meta-analysis. Included were all systematic reviews of randomized and non-randomized controlled trials on harms of antihypertensive drugs in English. Any other type of article was excluded. Change in focused on the older population.</p><p><strong>Results: </strong>The search resulted in 6353 items. A total of 105 articles were eligible for full-text screening, and 47 articles fulfilled eligible criteria and were included. Most common side effects included respiratory symptoms like dry cough (particularly under angiotensin-converting enzyme inhibitors), hypotensive symptoms, renal failure and electrolyte misbalances.</p><p><strong>Conclusion: </strong>Antihypertensives have a broad spectrum of side effects, but they are effective drugs against hypertension and reduce cardiovascular disease burden.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"425-432"},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological Management of ADHD in Women Across Perimenopause, Menopause and Post-Menopause.","authors":"Dora Wynchank, Sandra Kooij","doi":"10.1007/s40266-026-01291-z","DOIUrl":"10.1007/s40266-026-01291-z","url":null,"abstract":"<p><p>Attention-deficit/hyperactivity disorder (ADHD) in women is frequently underdiagnosed and undertreated, particularly during midlife when the neuroendocrine changes of perimenopause, menopause and post-menopause can exacerbate or unmask underlying symptoms. Clinical presentations of ADHD in the (peri)menopause often include worsening inattention, emotional dysregulation, and heightened anxiety or depressive symptoms, accompanied by vasomotor disturbances, sleep disruption and subjective cognitive complaints such as brain fog and memory impairment. This narrative review integrates current evidence concerning the pharmacological management of ADHD in women across the final reproductive hormonal transition. We outline diagnostic complexities arising from a symptomatic overlap between ADHD and (peri)menopausal symptoms. Evidence for the efficacy and safety of stimulant and non-stimulant medications in this population is limited, with no randomised controlled trials specific to (peri)menopausal women. Current practice relies on expert consensus, extrapolation from younger cohorts and small observational studies. Practical clinical guidance is provided for initiating and adjusting ADHD pharmacotherapy during hormonal transitions, incorporating individualised dosing, cardiovascular monitoring and consideration of comorbidities. The potential role of menopausal hormone therapy as an adjunctive strategy for mood, sleep and cognitive symptoms is discussed and practical guidance is provided for clinicians initiating pharmacotherapy in (peri)menopausal and post-menopausal women with ADHD, with an emphasis on interdisciplinary and collaborative patient-centred care. Research priorities include controlled trials evaluating stimulant-menopausal hormone therapy combinations and optimal dose adjustment protocols.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"385-395"},"PeriodicalIF":3.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13149623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalisation as an Opportunity to Optimise Quality Use of Medicines in Older Adults: A Systematic Review.","authors":"Crystal R Ucarer, Gregory M Peterson, Colin M Curtain, Mohammed S Salahudeen","doi":"10.1007/s40266-026-01299-5","DOIUrl":"https://doi.org/10.1007/s40266-026-01299-5","url":null,"abstract":"<p><strong>Background: </strong>Hospitalisation represents an opportunity to optimise medication therapy in patients at high risk of medication-related harm. Quality Use of Medicines (QUM) activities are typically incorporated into routine care, yet their impact as part of usual inpatient practice has not been comprehensively synthesised.</p><p><strong>Objective: </strong>The aims of this systematic review were to determine the extent to which hospitalisation serves as an opportunity for improving QUM in older adults receiving usual inpatient care, explore barriers and facilitators influencing the implementation and sustainability of QUM activities during hospitalisation, and identify which components of usual care most effectively improve medication appropriateness and safety.</p><p><strong>Methods: </strong>We conducted a systematic review of observational studies, identified using Medline, Embase, and International Pharmaceutical Abstracts, from January 2010 to May 2025. Eligible studies included older adults (≥ 65 years) admitted to hospital for at least 24 hours, where healthcare professionals delivered QUM-related activities as part of usual care during hospitalisation. Measurable changes in medications between admission and discharge using QUM indicators were reported. Methodological quality was assessed using the Joanna Briggs Institute (JBI) cohort checklist and findings were synthesised narratively.</p><p><strong>Results: </strong>Twenty-one studies met the inclusion criteria. Nineteen were rated as high quality and two as moderate quality. All studies evaluated changes in prescribing, most commonly using explicit tools such as the Beers criteria, Screening Tool to Alert to Right Treatment and guideline-based assessments of therapy. Ten studies showed usual care led to improvements in QUM indicators, including reduction in potentially inappropriate medicines (PIM) in settings with strong multidisciplinary involvement and structured medication reviews. However, 11 studies reported that QUM did not improve, with persistent or increased PIM use and polypharmacy at discharge. Factors contributing to ongoing QUM problems included limited clinician awareness, fragmented communication, inadequate documentation, constrained resources, poor integration of pharmacists, and variable use of QUM tools.</p><p><strong>Conclusion: </strong>Hospitalisation represents an important but inconsistently realised opportunity to optimise QUM in older adults. Inappropriate prescribing and polypharmacy frequently persist at discharge, indicating missed opportunities within usual care. System-level strategies embedding structured medication reviews, pharmacist involvement, explicit QUM tools, and robust documentation into routine practice may enhance medication safety.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}